Prevalence of malaria parasitaemia among pregnant women at booking in Nigeria

Abstract Background Malaria is a major public health concern among pregnant women in sub‐Saharan Africa. Within the region, Nigeria has the highest malaria cases. This study aimed to determine the prevalence and factors associated with malaria parasitaemia among pregnant women at a booking clinic in Ibadan, Nigeria. Methods A cross‐sectional study was conducted between January and April 2021 at the University College Hospital in Ibadan, Nigeria. A sample of 300 pregnant women participated, and anaemia and malaria were diagnosed using packed cell volume and Giemsa‐stained blood smears, respectively. Data analysis was done using SPSS 25.0. Results The study found that 26 (8.70%) pregnant women tested positive for malaria parasitaemia. Factors such as age, religion, level of education, and occupation were significantly related to the prevalence of malaria parasitaemia among pregnant women with p < 0.05. Conclusion Our study identified a high prevalence of malaria parasitaemia among pregnant women with demographic factors such as age, religion, level of education, and occupation significantly associated. Targeted malaria control interventions for pregnant women with low levels of education and low‐income occupations are necessary, with more research needed to evaluate their effectiveness.

abortion, and stillbirth. Symptoms and complications vary according to the level of immunity and the intensity of transmission in the area.
Most infections in pregnancy are asymptomatic, undetected, and untreated, leading to negative outcomes for both the mother and the foetus. 4 Women in their first and second pregnancies are the most vulnerable to Plasmodium falciparum infection. 5 This is due to increased immunity with more pregnancies. Severe malaria can lead to maternal death from complications such as hypoglycemia, cerebral malaria, and pulmonary oedema. 6 The burden of malaria during pregnancy also causes unwanted consequences, prolonged hospital stays, and psychological trauma for both patients and healthcare providers. 7 Pregnant women in Nigeria are particularly vulnerable to malaria infection due to various factors such as poor access to quality healthcare services, poverty, and demographic characteristics. 8 The burden of malaria is highest in rural areas, where access to health services is limited. The poverty rates in these areas make it challenging for pregnant women to access healthcare services and afford preventive measures such as insecticide-treated bed nets and antimalarial drugs. 9 This lack of access to quality healthcare services also means that many cases of malaria go undiagnosed and untreated, leading to severe complications for pregnant women and their fetuses.
Studies have found that demographic factors such as age, level of education, and occupation are significantly associated with malaria prevalence among pregnant women in Nigeria. 10,11 Younger pregnant women, those with low levels of education, and low-income occupations are more likely to be affected by malaria than their older, more educated, and higher-income counterparts. 12 These findings emphasise the need for targeted interventions that consider these demographic factors to effectively control the burden of malaria among pregnant women in Nigeria. Despite efforts to reduce the burden of malaria in Nigeria, the disease remains a significant challenge, particularly among vulnerable populations such as pregnant women. Continued investment in malaria prevention and control measures, including targeted interventions for pregnant women, is crucial to ensure the health and well-being of this vulnerable population.
The current prevalence of malaria in pregnancy at the University College Hospital in Ibadan booking clinic is unknown. A prospective review of malaria in pregnancy protocols is necessary to provide updated evidence and information. The results of this study will contribute to developing an evidence-based protocol for malaria during pregnancy in this clinical setting and similar settings in Nigeria, sub-Saharan Africa and beyond.

| Study area
The study was carried out at the Department of Obstetrics and A simple random sampling method was used to recruit participants for the study. The process involved assigning a unique identifier to each pregnant woman attending the antenatal clinic at the University College Hospital in Ibadan. The identifiers were then entered into a randomization tool, a Microsoft Excel sheet, which generated a list of 300 identifiers. The list of identifiers was used to recruit participants from the antenatal clinic until the desired sample size of 300 was achieved. This method ensured that each pregnant woman had an equal chance of being selected for the study without any biases or pre-selection based on any characteristics. Using a simple random sampling method, the study aimed to ensure that the sample was representative of the pregnant women attending the antenatal clinic at the University College Hospital in Ibadan.
Women were eligible for participation if they attended the antenatal clinic and agreed to participate. However, those who had already received antimalarial treatment or prevention, those who declined to participate, or those with sickle cell anaemia were excluded from the study. The principal investigator verified each participant's eligibility and obtained their informed consent, and the allocation numbers were recorded on the participant's forms for data analysis purposes.
Informed consent was obtained from each participant before the beginning of data collection. The process of obtaining informed consent was conducted thoroughly, which involved explaining the study's purpose and procedures, including the risks and benefits of participation. Participants were informed of their right to refuse or withdraw from the study at any time without consequence. During the informed consent process, potential participants received a copy of the informed consent form to read and sign. For participants who could not read or write, the informed consent form was read aloud and explained in detail by the research team. Participants who agreed to participate in the study were asked to sign or thumbprint the informed consent form.
Data collection was carried out using a structured questionnaire and laboratory investigations. The questionnaire was designed to collect detailed demographic characteristics such as age, religion, level of education, and occupation. The laboratory investigations utilized the gold-standard microscopy method to test for malaria parasitaemia, the recognized diagnostic technique for detecting malaria.
The study considered two main hypotheses: 1. The prevalence of malaria parasitemia among pregnant women at booking in Nigeria is high at the time of booking.
2. Sociodemographic factors such as age, religion, level of education, and occupation are associated with malaria parasitemia among pregnant women at booking in Nigeria.

| Study plan
The study obtained blood samples from pregnant women visiting the antenatal booking clinics who met eligibility criteria and provided informed consent. The samples were collected by the head researcher and sent to a laboratory for examination. The principal investigator then refined and analysed the information using participant data forms.

| Sample size determination
The sample size of 300 was calculated using the Cochrane formula 13 Considering an attrition rate of 10% = 25.3 Total sample size = 275 + 25 = 300.

| Data analysis
Statistical analysis was conducted using the Social Sciences Statistical Package (SPSS-25.0). The resulting data was analysed to generate tables, percentages, and Chi-square tests.

| Ethical considerations
The study was granted ethical approval from the Institutional Review Board of the University of Ibadan/University College Hospital.
Participants were thoroughly informed about the study procedures and allowed to participate voluntarily. They were assured that declining to participate would not impact their future medical care.
The study team obtained written consent from all individuals who agreed to participate.

| RESULTS
This study investigated the prevalence of malaria parasitaemia among pregnant women using a sample of 300 patients drawn at the University College Hospital, Ibadan booking clinic.     Table 3. Similarly, of the 34 patients who were anaemic, only 6 (17.7%) tested positive for malaria, indicating that nonmalaria-related anaemia is more prevalent among pregnant women at the booking stage.
The social-demographic characteristics of the respondents significantly associated with the prevalence of malaria parasitaemia among pregnant women at the booking stage are presented in   This study investigated the relationship between parity and malaria prevalence among pregnant women. The results revealed a statistically significant association, with primigravida having a higher malaria prevalence than multigravida. This finding may be explained by the acquired immunity that develops with increasing parity, reducing susceptibility to malaria infection in multigravida. These findings are consistent with a study conducted in Uganda, where primigravid women had an 84% higher risk of microscopic parasitaemia at enrollment and nearly three times the risk of placental malaria compared to multigravida women. 20 Additionally, Ugwu et al. 21 reported a higher prevalence of malaria parasitaemia among primigravidae (95.8%) compared to multigravida (90.2%). The association between parity and malaria prevalence among pregnant women is important for malaria prevention and control strategies.

| LIMITATIONS OF STUDY
This study had some limitations. One potential limitation of this study is that it was conducted in a single hospital in Nigeria and, therefore, may not represent pregnant women in other regions or healthcare settings. Furthermore, the study relied on self-reported participant data, which may introduce the possibility of recall bias or social desirability bias. Finally, the study did not include a comparison group of nonpregnant women or men, which limits the ability to conclude the prevalence of malaria parasitaemia in the general population.
Statistical limitations of the study include the lack of adjustment for potential confounding factors in the analysis of the relationship between occupation and malaria parasitaemia and the lack of multivariable analysis to identify independent risk factors for malaria parasitaemia among pregnant women. Despite these limitations, the T A B L E 5 Relationship between the obstetrics history and the prevalence of malaria parasitaemia among pregnant women.

CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.

DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Data may be made available upon reasonable request from the corresponding author.
The data are not publicly available due to privacy or ethical restrictions.

ETHICS STATEMENT
The study received ethical clearance from the University of Ibadan/ University College Hospital Institutional Review Committee. Participants were informed of the study procedures and allowed to participate voluntarily. Those who chose not to participate would not be affected in their future care. Written consent was obtained from all participants before their inclusion in the study.

TRANSPARENCY STATEMENT
The lead author Nicholas Aderinto affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.